Background

Hannah Lemke and her colleagues (2022) published: “Association of disease course and

brain structural alterations in major depressive disorder” in the peer-reviewed journal

Depression and Anxiety earlier in this year in order to study the impact of cumulative disease

burden over a lifetime on the structure of the brain in patients with Major Depressive

Disorder (MDD). The journal has an impact factor of 6.505 in 2021 to 2022 and this can be

considered a very outstanding achievement.

This journal article is the result of many months of serious efforts by 25 researchers.

All the authors are highly qualified professionals either with a master's degree or doctoral

degree and some are doctor of medicine. They represent their professional fields in medicine,

psychiatry, psychology, radiology and neuroscience.

The purpose of this study was to incorporate multiple clinical variables of MDD

illness history and relate these measurements to morphological changes in the brain of a large

sample of MDD patients in order to offer a reliable measure of disease course for clinical

research and treatment. The purpose of the research is clearly and concisely stated and the

title is self-explanatory.

Lemke et al. (2022) claim that the reliability of a single clinical variable used to

define the course of the disease was low. They also claim that the more severe course of the

disease had a detrimental effect on brain morphology, but the circumstances under which

these changes occurred remain unclear. This is a highly concise article and require readers to

read and reread several times before one can capture the essence of this article. A major

strength of this research is large number of participants which involved as many as 681

patients. The sample also include 66.6% female and 33.4% male which both genders were

fairly well represented.

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Method

Specifically, the objectives of this study are: (a) using a PCA, identify a similar two-

component structure with Hospitalization and Duration of Illness that characterises the

lifetime disease history; (b) using a regions of interest (ROI) strategy, they anticipated

negative relationships between component scores and GMV reductions in these three brain

regions. The objectives of this study was stated clearly in this research.

This research is conducted by using voxel-based-morphometry among 68l patients

who recruited in psychiatric hospitals or through newspaper advertisements. This research

was conducted in Münster and Marburg, two different sites in Germany. Structured Clinical

Interview (SCID‐I) where done on all the patients to asses clinical diagnoses according to

DSM‐IV‐TR criteria. During interviews, participants; disease course were obtained that

included the following variable: number of lifetime psychiatric hospitalizations, cumulative

lifetime duration of psychiatric hospitalizations, time since the first psychiatric symptoms,

number of lifetime depressive episodes and cumulative lifetime duration of depressive

symptoms.

Ethical Considerations

This study was conducted following the ethical guideline and regulations. Approval was

granted by the ethics committees of the Medical Faculties of the University Münster and

Marburg. Written informed consent were given by all the participants who received financial

compensation for their participation.

Results and Discussion

This study found that previous lifetime course was associated with lower GMV in bilateral

DLPFC, left hippocampus and left insula through data reduction for several clinical variables.

In contrast, these negative associations did not interact with other sample or disease

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characteristics such as age, gender, acute symptom severity, remission status and psychiatric

comorbidity.

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